SURGICAL ANESTHESIA 

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THE 

SEMI-CENTENNIAL OF 

ANAESTHESIA 

OCTOBER 1 6, 1846 
OCTOBER 16, 1896 



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BOSTON 
MASSACHUSETTS GENERAL HOSPITAL 

1897 



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CAMBRIDGE, MASS., U. S. A. 

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WITHDRAWN. 



PROGRAMME 



I. ADDRESS OF WELCOME. 

By CHARLES H. DALTON, Esq., President 

of the Massachusetts General Hospital. 

II. REMINISCENCES OF 1846. 

By ROBERT T. DAVIS, M. D., of Fall River. 

III. SURGERY BEFORE THE DAYS OF ANAES- 

THESIA. 

By JOHN ASHHURST, JR., M. D., LL. D., of 
Philadelphia. 

IV. WHAT HAS ANESTHESIA DONE FOR SUR- 

GERY. 

By DAVID W. CHEEVER, M. D., LL. D., of 

Boston. 

V. RELATION OF ANAESTHESIA AND OBSTET- 
RICS. 

By JOHN P. REYNOLDS, M.D., of Boston. 

VI. THE INFLUENCE OF ANESTHESIA UPON 
MEDICAL SCIENCE. 

By W. H. WELCH, M. D., LL. D., of Baltimore. 

VII. .THE SURGERY OF THE FUTURE. 

By CHARLES McBURNEY, M. D., of New 

York. 

VIII. THE BIRTH AND DEATH OF PAIN. 

A Poem, by S. WEIR MITCHELL, M. D., 
LL. D., of Philadelphia. 



HONORARY COMMITTEE 



JOHN SHAW BILLINGS, M. D., LL. D., New York, Chairman. 

CHARLES W. ELIOT, LL. D., President of Harvard University. 

HENRY P. WALCOTT, M. D., President Mass. Medical Society. 

MORRILL WYMAN, M. D., LL. D., Cambridge. 

CLAUDIUS HENRY MASTIN, M. D., LL. D., Mobile. 

ROBERT F. WEIR, M. D., New York. 

HUNTER McGUIRE, M. D., LL. D., Richmond. 

PHINEAS SANBORN CONNER, M. D., LL. D., Cincinnati. 

WILLIAM WILLIAMS KEEN, A. M., M. D., LL. D., Philadelphia. 

HORATIO C. WOOD, M. D., LL. D., Philadelphia. 

WILLIAM PEPPER, M. D., LL. D., Philadelphia. 

HENRY H. MUDD., M. D., St. Louis. 

LOUIS McLANE TIFFANY, A. M., M. D., Baltimore. 

NICHOLAS SENN, M. D., Ph. D., LL. D., Chicago. 

CHARLES McBURNEY, M. D., New York. 

NATHANIEL PENDLETON DANDRIDGE, M. D., Cincinnati. 

FRANCIS JOHN SHEPHERD, M. D., Montreal. 

J. WILLIAM WHITE, M. D., Ph. D., Philadelphia. 

WILLIAM OSLER, M. D., Baltimore. 

WILLIAM J. MORTON, M. D., New York. 

FREDERIC SHEPARD DENNIS, M. D., New York. 

WILLIAM S. HALSTED, M. D., Baltimore. 

ROSWELL PARK, A. M., M. D., Buffalo. 

LEVI C. LANE, M. D., LL. D., San Francisco. 



<*<••* 




COMMITTEE OF ARRANGEMENTS 



J. COLLINS WARREN, M. D., LL. D. 

CHAIRMAN 

JAMES C. WHITE, M. D. 
WILLIAM L. RICHARDSON, M. D. 

HENRY H. A. BEACH, M. D. 

FREDERICK C. SHATTUCK, M. D. 

WILLIAM STURGIS BIGELOW, M. D. 




ADDRESS OF WELCOME 

BY CHARLES H. DALTON, Esq. 

PRESIDENT OF THE 

MASSACHUSETTS GENERAL 

HOSPITAL 



ADDRESS OF WELCOME 




ENTLEMEN AND LADIES: It is my 

privilege, on behalf of the Corporation of 
I the Massachusetts General Hospital, to 
welcome you here to-day as guests of this 
venerable institution. Though somewhat 
less than a century old, the hospital is one of the ear- 
liest in the country. It has long passed its infancy and 
youth, and has reached a period in its life already rich 
in history and traditions. 

In 1810 two distinguished members of the profession, 
being impressed with the importance of founding a gen- 
eral hospital in this growing city and neighborhood for 
the better care of the sick and wounded, for the larger 
opportunities for the study of the art of healing and sci- 
entific investigation of the causes of disease, addressed a 
letter to their fellow-citizens asking their cooperation for 
this purpose. 

In the following year the Commonwealth gave a char- 
ter and a generous grant, known as the Province House 
Estate, and the merchants and other citizens responded 
with equal liberality to the appeal of Drs. James Jackson 
and John Collins Warren, which resulted in the building 
of the central part of the hospital, — a structure which, 
both in respect to its architectural dignity and its honest 
workmanship, as well as its fitness for its purposes, is a 
fair monument to the characters of its first projectors. 

13 



address of Since then, for three generations, the institution has 

never failed to have at its service the highest professional 
skill in all its constantly growing departments and scien- 
tific development, and the sympathy and confidence of 
the public. 

During these eighty-four years there has been an 
annually increasing procession of patients seeking its 
protecting shelter, who have been tenderly cared for, 
whether on free beds or otherwise, and in this most 
important function the hospital has amply realized the 
purposes of its enlightened and humane founders. 

I do not refer to this record as being in any degree 
peculiar to this hospital. It is simply the story of the 
performance of its duty to the public, and for which it 
was chartered by the Commonwealth. It is, in general, 
the common history of all similar institutions, illustrat- 
ing perhaps, in the most sincere form, man's humanity 
to man. But it is, nevertheless, a record which has 
amply justified its foundation, and should insure its pres- 
ervation in the years to come. 

If, however, we could imagine all this record erased ; 
if all the intelligence of the physician, the skill of the 
surgeon, the watchfulness of the nurse, the benefactions 
of the public, and, more than all, the saving of life and 
relief of suffering, were as naught, — there would still re- 
main one page in its history which of itself alone would be 
more than a recompense for the loss of all the rest, inas- 
much as of what was inscribed thereon the whole world 
has been the beneficiary, and incidentally has raised the 
name of The Massachusetts General Hospital to an hon- 
orable distinction at home and abroad. 

Fifty years ago to-day in the operating theatre, then 
under yonder dome, Sulphuric Ether was first used for 
the prevention of pain to a patient undergoing a serious 

14 



operation. This application was made by Mr. W. T. G. address of y 

m * ^i • , WELCOME 

Morton. The experiment was a success. 

Of the infinite blessings which followed this the great- 
est gift of the century to mankind, of its contributions to 
the relief and safety of suffering humanity, to the surer 
confidence and success of the physician and surgeon in 
his efforts for the saving of human life, and in scientific 
investigation, it is not my function to speak. These 
themes are for the scholar and scientist. 

I have simply to express to you the cordial welcome of 
the Corporation to this celebration of the fiftieth anni- 
versary of the first surgical operation under which the 
patient suffered no pain, no discomfort, no anxiety. 

The occasion is unique. 

*5 



REMINISCENCES OF 1846 

BY ROBERT T. DAVIS, M. D. 
OF FALL RIVER 



9 




REMINISCENCES OF 1846 



R. PRESIDENT AND GENTLEMEN: 

Fifty years ago to-day occurred the first 
authentic, unquestionable, public exhibition 
of anaesthesia during a surgical operation. 
As one of the few surviving witnesses of 
that memorable event, the most important in surgical, 
and one of the most important in human history, I have 
been invited to state my recollection of the incidents 
attending it, and very gladly comply with the request. 

The operation in which the anaesthetic was adminis- 
tered was performed in the surgical amphitheatre of the 
Massachusetts General Hospital by Dr. John C. Warren, 
in the presence of a number of distinguished surgeons 
and physicians, including Dr. Hayward, the elder Dr. 
Bigelow, one of the wisest and greatest men who have 
adorned our profession with their multifarious gifts and 
accomplishments, and his celebrated son, not then arrived 
at the zenith of his fame. The Harvard medical class was 
also present. After some delay Dr. William Morton ap- 
peared with his apparatus, when Dr. Warren addressed 
the medical class, which had not been previously notified 
of the proposed experiment, stating in substance that 
there was a gentleman present who claimed that he had 
discovered that the inhalation of a certain agent would 
produce insensibility to pain during surgical operations 
with safety to the patient, and he added that the class 

J 9 



reminiscences was aware that he had always regarded that condition as 
OF l846 an important desideratum in operative surgery, and he 

had decided to permit him to try the experiment. 

The patient, who was a young man, was suffering from 
a vascular tumor of the neck on the left side, occupying 
the space from the edge of the jaw downward to the lar- 
ynx and from the angle of the jaw to the median line. 
Dr. Morton proceeded to apply to the lips of the patient 
a tube connected with a glass globe. After the inhalation 
had continued four or five minutes he appeared to be 
asleep, and the operation was commenced and completed 
without further inhalation of the ether. It consisted of 
an incision about three inches in length over the centre 
of the tumor, and through the skin and subcutaneous 
cellular tissue, and the removal of a layer of fascia, which 
covered the enlarged blood-vessels. A curved needle 
armed with a ligature was then passed under and around 
the tumor, and considerable compression was employed. 

During most of the time occupied by the operation 
the patient gave no sign of sensibility, and appeared to 
be sleeping quietly, A short time before its completion 
he moved his head, body, and limbs, and muttered words 
which I could not hear distinctly, but upon recovering 
consciousness he declared that he had suffered no pain, 
but simply a sensation like scraping the parts with a 
blunt instrument. 

The exhibition of the anaesthetic was admitted by 
those present to be a complete success. The operating 
surgeon expressed his satisfaction in these emphatic 
words : " Gentlemen, this is no humbug." From that 
time forward it became the practice to employ it at the 
hospital in all operations of importance. 

Dr. Morton continued to administer it until it was 
proved that it could be easily and safely administered by 
others. The apparatus which he had used in the first 

20 



and a few subsequent instances was soon abandoned as reminiscences 
unnecessary and attended with possible risk, and a con- OF l846 
cave sponge was substituted. Sulphuric ether as an anaes- 
thetic very promptly passed into general use in Boston 
and throughout the State, and soon afterward in public 
and private practice in the large cities of other States, 
followed by its employment all over the country wherever 
scientific surgery was practised. Its fame crossed the 
ocean, and it rapidly became a necessary adjunct to sur- 
gery in Europe as well as here, and beyond, even to the 
utmost limits of civilization ; it did not stop there, but 
among savage tribes and barbarous races in distant conti- 
nents and islands it followed the footsteps of the explorer, 
the trader, and the missionary on its divine errand of 
mercy to mankind. 

It is impossible to estimate or comprehend the impor- 
tance of this beneficent discovery. It safely and abso- 
lutely secures insensibility to pain, unconsciousness and 
immobility for long periods of time, conditions which are 
essential to the successful performance of prolonged and 
delicate surgical operations. We know the pain and 
terror which accompanied ordinary surgical operations 
before the advent of anaesthesia. I cannot forget the 
impression produced by the case of a naval officer, upon 
whom a painful operation was performed at this hospital. 
The suffering was so great that he repeatedly screamed, 
and was quite unable to suppress the exhibition of his 
agony. He afterward apologized to the gentlemen pres- 
ent, and stated that he could not control the expression 
of unendurable pain he had experienced, and to which 
his haggard features and shaking frame bore undoubted 
testimony. 

It was fitting that the discovery of anaesthesia should 
be ushered to the world from this historic institution, 
dedicated to the service of humanity, in the broadest 



21 



reminiscences spirit of charity, by the gifts of noble men and women. 

OF l846 It was fitting, also, that the most eminent surgeon of 

his day in New England permitted the experiment and 
performed the operation. His name will be always hon- 
ored and gratefully remembered, by the profession and 
the public, for his courage and wisdom in assuming the 
responsibility of sanctioning what might have proved a 
hazardous experiment, whose failure would have compro- 
mised his great reputation. Such considerations had no 
terrors for him ; he thought only of the lasting and lim- 
itless blessings which would follow success. These qual- 
ities he inherited from an illustrious ancestry. He was 
the son of a Revolutionary patriot and military surgeon, 
who was for forty years the most distinguished member 
of our profession in New England, and a nephew of the 
heroic Warren, who left a profession, whose duty it is to 
save human life, to offer up his own in defence of Amer- 
ican liberty in the first pitched battle of the Revolution, 
and whose name is on the lips of every schoolboy who 
has read the immortal story of our nation's birth. Blessed 
forever be the memory of Joseph Warren, who fell at 
Bunker Hill, and that of John Collins Warren, who aided 
so signally the renowned discovery of anaesthesia, to 
whom all generations will be debtors, in conferring that 
unequalled boon upon his fellow-men. 

Let me add that discoveries of such permanent and 
universal interest and importance are not accidental. 
Such an assumption would be an impeachment of the 
order of the universe and the designs of Providence. 
They are the natural and indeed inevitable result of the 
progress of scientific thought and investigation. The 
eager quest of previously unknown facts which distin- 
guishes our age reaches the very threshold of discovery, 
when some fortunate explorer takes a step in advance, 
ascertains the new truth and proclaims it to the world. 

22 




c/ <f 



The history of surgical anaesthesia furnishes no exemp- reminiscences 
tion from this general law. In the noon of this grandest l 4 
of the centuries, the spirit of humane science whispered 
these glad tidings ; the attentive ear of Morton heard the 
message and transmitted it to mankind. Thenceforth this 
matchless discovery was destined to bestow its blessings, 
so long as the race shall endure, wherever in all time 
human suffering cries aloud for succor or languishes in 
silent despair, and the divine attribute of mercy, aided by 
the wisdom of science, flies to its relief. 

23 






SURGERY BEFORE THE DAYS 
OF ANAESTHESIA 

BY JOHN ASHHURST, JR., M. D., LL. D. 
OF PHILADELPHIA 



SURGERY BEFORE THE DAYS 
OF ANAESTHESIA 




R. PRESIDENT and Gentlemen of the 
Board of Trustees and Hospital Staff, La- 
dies and Gentlemen : A study of the con- 
dition of operative surgery before the days 
of anaesthesia reveals on the one hand a 
picture of heroic boldness and masterly self-control on 
the part of the surgeon, and on the other a ghastly pan- 
orama, sometimes of stoic fortitude and endurance, 
sometimes of abject terror and humiliation, but always 
of agonizing wretchedness and pain, on the part of the 
unhappy victim, man or woman, whose necessities re- 
quired a recourse to the surgeon's aid. And from our 
vantage ground of a half century's experience it is diffi- 
cult for us to understand why, with the constant and 
persistent efforts made by surgeons in past ages to lessen 
the pain of operations, and with the gradual but contin- 
uous accumulation of facts showing that by certain 
agents pain could be temporarily abolished without dan- 
ger, the eyes of all — patients as well as practitioners — 
yet seemed to be holden, and why, science and art work- 
ing with a common object, if independently, though the 
whole world seemed to be trembling on the verge of the 
discovery, it yet was not until fifty years ago to-day that 
the crucial experiment was made in this hospital, and that 
surgical anaesthesia became a glorious reality. 

27 



surgery It is somewhat difficult to obtain an accurate picture 

the days of of pre-anaesthetic surgery from the patient's point of view, 
anesthesia probably for a similar reason to that indicated by the 
lion in the fable, when he criticised the artist for always 
representing a combat between lions and men as termi- 
nating in a human victory, — lions do not paint ; and so, 
as operations are habitually reported by surgeons and not 
by patients, we read of the skill and intrepidity of the 
operator, of difficulties met and overcome, and of victo- 
ries snatched as it were from the very jaws of impending 
defeat ; but we hear little of the tortures of the victim 
under the life-saving process, or, in an unsuccessful case, 
of the gradual subsidence of agonizing cries hushed in 
the silence of death. And yet we sometimes catch, inci- 
dentally, a side-glimpse of an operation from the patient's 
standpoint, and can thus form some faint notion of the 
shades as well as of the high lights of capital surgery in 
days gone by. 

Those who are familiar with the history of British sur- 
gery seventy years ago will recall the famous case of 
Cooper vs. Wakley, in which the enterprising founder 
and proprietor of the " Lancet " was sued and mulcted, 
though in but nominal damages, for the report of an op- 
eration for lithotomy performed by Sir Astley Cooper's 
nephew, Mr. Bransby B. Cooper. The report opens 
with a quotation from John Bell, referring to "long and 
murderous operations, when the surgeon labors for an 
hour in extracting the stone, to the inevitable destruc- 
tion of the patient," and then, having described in terms 
as graphic as uncomplimentary the operator's prolonged 
efforts to remove the calculus, and the words which 
showed his own anxiety and discomposure during the 
process, adds : " Such were the hurried exclamations of 
the operator. Every now and then there was a cry of 
' Hush ! ' which was succeeded by the stillness of death, 

28 



broken only by the horrible squash, squash, of the for- surgery 
ceps in the perineum. ' Oh ! let it go — pray let it keep the°days of 
in ! ' was the constant cry of the poor man." The pa- anesthesia 
tient was on the table nearly an hour, and after a night 
and a day of great pain "death," adds the reporter 
"ended the poor fellow's sufferings, about twenty-nine 
hours after the operation." The fatal result appeared 
to have been due to peritonitis. It is, indeed, not an 
unheard-of thing that a surgeon's presence of mind 
should fail him in a difficult operation, even at the pres- 
ent day; but at least the patient, unconscious through 
the blessing of anaesthesia, does not know it, and this 
complication is spared, to the great comfort of all con- 
cerned. 

The " pitilessness " which Celsus urged as an essential 
trait in the operative surgeon — though Percy and Lau- 
rent declare that this pitilessness was meant to be appar- 
ent only — was, indeed, before the days of anaesthesia, 
a feature in the surgeon's character which impressed 
very strongly the public generally, as well as those imme- 
diately connected with the operation ; and it may be feared 
that there are not wanting, even at this nineteenth cen- 
tury's end, some who would echo the comment of the 
younger Pliny upon the operative surgeons of his time : 
" They make experiments through deaths, and no head 
is secure from them." 

It is interesting to recall that Sir James Simpson, of 
Edinburgh, shortly after beginning his professional stud- 
ies, was so affected by " seeing the terrible agony of a 
poor Highland woman under amputation of the breast," 
that he resolved to abandon a medical career, and seek 
other occupation ; happily, his intention was reconsid- 
ered, and he returned to his studies, asking himself, 
"Can anything be done to make operations less pain- 
ful?" and, as every one knows, in less than twenty years 

29 



SURGERY 

BEFORE 

THE DAYS OF 

ANESTHESIA 



became himself a high priest of anaesthesia, and the in- 
troducer into surgical and obstetrical practice of ether's 
great rival, chloroform. 

Not only did delicate women and tender children 
dread the ordeal of the surgeon's knife, but strong and 
brave men also recoiled from its use in horror : Buffon 
preferred death to relief from the agonies of calculus by 
the operation of lithotomy ; and case after case is narrated 
by Monfalcon and other writers in which men submitted 
themselves with the utmost calmness and fortitude to the 
hands of skilful operators, instantly falling into collapse 
after the first incision, and, without undue loss of blood, 
quickly succumbing to the depressing effects of simple 
shock and pain. 

No braver or more gallant gentleman ever lived than 
Admiral Viscount Nelson, and, after his right elbow had 
been shattered by a French bullet in the assault at Ten- 
eriffe, he manifested the utmost courage, refusing to be 
taken to the nearest ship lest the sight of his injury 
should alarm the wife of a fellow-officer whose own fate 
was uncertain, arid when his own ship was reached, 
climbing up its side without assistance, and saying, " Tell 
the surgeon to make haste and get his instruments. I 
know I must lose my right arm, so the sooner it is off 
the better." " He underwent the amputation," we learn 
from a private letter of one of his midshipmen, " with the 
same firmness and courage that have always marked his 
character;" and yet so painfully was he affected by the 
coldness of the operator's knife that though, when next 
going into action at the famous battle of the Nile, he 
could after calmly finishing his meal say to his officers, 
" By this time to-morrow I shall have gained a peerage 
or Westminster Abbey," yet he gave standing orders to 
his surgeons that hot water should always be kept in 
readiness during an engagement, so that if another oper- 

30 



ation should be required, he might at least have the poor surgery 
comfort of being cut with warm instruments. the°days of 

But the most striking picture of which I am cogni- an ^sthesia 
zant, showing the way in which an intelligent patient 
looked upon a surgical operation, is to be found in a let- 
ter written to Sir James Simpson by a friend, himself a 
member of the medical profession, who had had the mis- 
fortune to lose a limb by amputation before the introduc- 
tion of anaesthesia : " I at once agreed," he says, " to sub- 
mit to the operation, but asked a week to prepare for it, 
not with the slightest expectation that the disease would 
take a favorable turn in the interval, or that the antici- 
pated horrors of the operation would become less appall- 
ing by reflection upon them, but simply because it was 
so probable that the operation would be followed by a 
fatal issue that I wished to prepare for death, and what 
lies beyond it, whilst my faculties were clear and my emo- 
tions were comparatively undisturbed. . . . The week, 
so slow and yet so swift in its passage, at length came to 
an end, and the morning of the operation arrived. . . . 
The operation was a more tedious one than some which 
involve much greater mutilation. It necessitated cruel 
cutting through inflamed and morbidly sensitive parts, 
and could not be despatched by a few strokes of the 
knife. ... Of the agony it occasioned I will say nothing. 
Suffering so great as I underwent cannot be expressed in 
words, and thus fortunately cannot be recalled. The 
particular pangs are now forgotten ; but the blank whirl- 
wind of emotion, the horror of great darkness, and the 
sense of desertion by God and man, bordering close 
upon despair, which swept through my mind and over- 
whelmed my heart, I can never forget, however gladly I 
would do so. Only the wish to save others some of 
my sufferings makes me deliberately recall and confess 
the anguish and humiliation of such a personal experi- 

31 



SURGERY 

BEFORE 

THE DAYS OF 

ANESTHESIA 



ence; nor can I find language more sober or familiar 
than that I have used to express feelings which, happily 
for us all, are too rare as matters of general experience 
to have been shaped into household words. . . . During 
the operation, in spite of the pain it occasioned, my 
senses were preternaturally acute, as I have been told 
they generally are in patients under such circumstances. 
I watched all that the surgeon did with a fascinated inten- 
sity. I still recall with unwelcome vividness the spread- 
ing out of the instruments, the twisting of the tourniquet, 
the first incision, the fingering of the sawed bone, the 
sponge pressed on the flap, the tying of the blood-vessels, 
the stitching of the skin, and the bloody dismembered 
limb lying on the floor. Those are not pleasant remem- 
brances. For a long time they haunted me, and even 
now they are easily resuscitated ; and though they cannot 
bring back the suffering attending the events which gave 
them a place in my memory, they can occasion a suffer- 
ing of their own, and be the cause of a disquiet which 
favors neither mental nor bodily health." 

On the side of the surgeon, we find throughout the 
ages a constant effort to diminish the terrors of opera- 
tions, and a continuous reprobation of the distressful, 
not to say cruel, modes of practice adopted by preceding 
generations. " Who can read without a kind of hor- 
ror," cries Monfalcon, " the account of those frightful 
operations which were then practised ? And yet the time 
is not very far distant from ours when they lopped off a 
limb by striking it violently with a heavy knife ; that 
time when they knew neither how to stop nor how to 
prevent hemorrhage but by burning the part whence the 
blood jetted with boiling oil or the red-hot iron; that 
time when surgeons armed themselves at every moment 
with pincers, with burning cauteries, and with a thousand 
instruments the representations even of which cause ter- 

32 



ror." Will it happen that on the occasion of some future surgery 
anniversary our successors will speak of our operative tri- the°days of 
umphs with the same scorn and abhorrence with which anesthesia 
writers of the present day sometimes refer to the great 
deeds of our surgical forefathers ? 

The belief that operations might be rendered painless, 
and the hope that some means might be discovered by 
which this end should be accomplished, appear to have 
been present in the minds of surgeons from the earliest 
periods. Witness the accounts of the Memphis stone, 
described by Dioscorides and Pliny, which Littre sur- 
mised to have been merely marble, which by steeping in 
vinegar was made to give forth the fumes of carbonic 
acid; and of the mandragora, employed according to Theo- 
doric, when mixed with other narcotics, by inhalation, 
and causing a sleep from which the patient could only be 
aroused by the fumes of vinegar : so profound was the 
stupor induced by this drug that Bodin assures us that 
under its influence a man^ubmitte^ without conscious- 
ness to a painful operation, anHVontinued to sleep for 
several days thereafter may ^ 1902 

Vigo speaks of the wj^pl^body being " broug^^tsleep by 
the smelling of a spongewfe^rtit^c^iiofitis,'' but warns his 
readers that the practice is dangerous, because the use of 
opium is sometimes followed by gangrene. In his work 
on " Natural Magic," Baptista Porta speaks of a volatile 
drug, kept in leaden vessels, which produced sleep when 
applied to the nostrils; and Perrin suggests that this may 
actually have been ether, or some other of our modern 
anaesthetic agents. 

Others endeavored to prevent the pain of operations 
by mechanical means. The Assyrians, Hoffman assures 
us, compressed the veins of the neck, apparently by tying 
a band around the part, before practising circumcision, 
and compression of the carotid arteries was suggested as 

33 



surgery an anaesthetic measure in more modern times by Dr. 

the days of Fleming ; while still more recently Dr. Augustus Waller 
anesthesia ^as s h own that insensibility may be induced by compress- 
ing the cervical vagi. Garroters have, indeed, clearly 
shown, as remarked by Simpson, that a person may read- 
ily be choked into unconsciousness, but it is not surpris- 
ing that their mode of practice has not commended itself 
to surgeons for general adoption. 

Compression of the limb by a fillet or tight ligature, 
before amputation, is referred to by Pare as a mode of 
alleviating the suffering which attends that procedure ; 
and Benjamin Bell tells us that, "in amputating limbs, 
patients frequently desire the tourniquet to be firmly 
screwed, from finding that it tends to diminish the pain 
of the operation." The same writer refers approvingly 
to the suggestion of Mr. James Moore, that pain should 
be controlled by the application of a screw compressor 
to the principal nerve of the part, but surgeons generally 
appear to have agreed with Monfalcon that the inconven- 
iences of such an apparatus fully equalled its very slight 
advantages. 

Mental preoccupation was sometimes sought as a 
means of preventing pain. Richard Wiseman found 
that soldiers dreaded the loss of a limb much less if it 
was removed immediately, while they were " in the heat 
of fight," than if the operation was postponed until the 
next day ; "wherefore," he says, "cut it off quickly, while 
the soldier is heated and in mettle ; " and Renauldin 
recalls the case of the amiable Dolomieu, who, exposed 
to the pangs of starvation in a Neapolitan dungeon, 
measurably alleviated his own distress by engaging in 
the composition of a Treatise on Mineralogy, while his 
unfortunate servant and fellow-prisoner, who had not the 
same intellectual resources, was hungry enough for both. 
But the presence of pain was not the only evil 

34 



dreaded by our predecessors in attempting important surgery 
operations : the great risk of fatal accident from some the days of 
involuntary movement of the patient was constantly pres- AN ^ STHESIA 
ent to the mind of the conscientious surgeon. " How 
often," says Dr. Valentine Mott, " when operating in 
some deep, dark wound, along the course of some great 
vein, with thin walls, alternately distended and flaccid 
with the vital current, — how often have I dreaded that 
some unfortunate struggle of the patient would deviate 
the knife a little from its proper course, and that I, who 
fain would be the deliverer, should involuntarily become 
the executioner, seeing my patient perish in my hands 
by the most appalling form of death ! Had he been 
insensible, I should have felt no alarm." So greatly was 
the responsibility of using the knife felt by the best- 
informed surgeons of pre-anaesthetic days, that many, 
like Haller, distrusted their own manual dexterity, and 
declined to perform operations which, while recognizing 
their necessity, they felt should be left to other surgeons 
differently constituted from themselves. Would that a 
little of this Hallerian diffidence might affect some tyros 
of the profession in our own day, who, without the 
slightest preliminary practical training, do not hesitate 
to undertake the most hazardous procedures, and seem 
to consider themselves disgraced if they cannot count 
one or more abdominal sections, even if terminating 
fatally, within the accomplishments of their first year's 
practice ! 

Coming down to the days more immediately preced- 
ing the date of the great discovery, we find that opium 
and alcohol were the only agents which continued to be 
regarded as of practical value in diminishing the pain of 
operations, though the attendant disadvantages of their 
employment were of course recognized. " Previous to 
every painful operation," says Dorsey, " a dose of lauda- 

35 



SURGERY 

BEFORE 

THE DAYS OF 

ANESTHESIA 



num should be administered." " I was in the habit," says 
Dr. Mott, " of giving opiates freely before the introduc- 
tion of anaesthetics, both before and after operations, . . . 
and opium and its preparations are the only anodynes 
well adapted to surgical use. No substitutes are worthy 
of confidence." Demme tells of a woman who, under 
the influence of opium, submitted to amputation at the 
hip-joint, and emitted but a single cry; and I myself 
recall distinctly patients who, in the hands of that 
excellent surgeon, the late Dr. George W. Norris, had 
limbs amputated with almost no manifestation of pain 
when well charged previously with opium and whiskey. 
Alcohol, pushed to the point of producing intoxication, 
was employed as an anaesthetic by some surgeons ; and 
Dorsey tells us that Dr. Physick, following Richerand's 
suggestion, used it successfully for its relaxing effect in 
a rebellious case of dislocated jaw, in which, on account 
of the patient's " extreme debility," it was not thought 
prudent to resort to the usual remedy, " blood-letting ad 
deliquium animi!' 

Meanwhile facts were accumulating, the significance 
of which we can now plainly recognize, but which excited 
no attention at the time. Sir Humphry Davy had, in 
the very early days of the nineteenth century, experi- 
mented with nitrous oxide, gas, afterwards employed by 
Horace Wells, and had in so many words suggested its 
use as an anaesthetic in minor operations ; its power of 
preventing the sensation of pain was well known to many 
persons, and it was the custom at some of our medical 
schools — at the University of Pennsylvania for one — 
for students to breathe the " laughing gas," as it was then 
called, for diversion. The use of ether by inhalation had 
been still earlier recommended by Beddoes, Pearson, and 
Thornton as a remedy for certain diseases of the lungs, 
and in 1805 your own Warren had employed it "to 

36 



relieve the distress attending the last stage of pulmonary surgery 

inflammation." Its intoxicating qualities when inhaled, the°days of 

and its power, when in sufficient concentration, to pro- anesthesia 

duce stupefaction, had been recognized, in 1839, in 

Pereira's well-known treatise on Materia Medica, and 

were quite familiar to American medical students ; and 

it is no doubt possible — I certainly have no wish to deny 

it — that in isolated cases it may have been used as a 

means of relieving pain by individual practitioners, as by 

Dr. Long, of Athens, Georgia, whom Perrin, with that 

happy disregard of the geography of all countries except 

their own which is characteristic of French writers, calls 

the " Greek physician." 

But yet — and yet — surgeons went on, in every coun- 
try, cutting and burning, and patients went on writhing 
and screaming, until on the sixteenth day of October, in 
the year 1846, in the Massachusetts General Hospital, Dr. 
John C. Warren painlessly removed a tumor from a man 
who had previously been etherized by Dr. William T. G. 
Morton — and Surgical Anaesthesia became the priceless 
heritage of the civilized world. 

37 



WHAT HAS ANESTHESIA DONE 
FOR SURGERY 

BY DAVID W. CHEEVER, M.D., LL. D. 
OF BOSTON 



9 




WHAT HAS ANESTHESIA DONE FOR 

SURGERY 



HAT victim of surgery, who, under ether, 
sinks into a calm and dreamless sleep, 
during which his abdomen can be cut 
open, his bowels taken out, handled, and 
replaced, his nerves cut, his veins or ar- 
teries tied, and his skin sewed up, and who is made so 
absolutely oblivious as to ask on awakening, " Are you 
not ready to begin ? " but concedes with gratitude, on 
realizing the result, that this is the greatest discovery 
ever made for the happiness of mankind ? 

In proportion as anticipation is worse than reality, 
must be estimated the mental relief brought about by 
anaesthesia. To dread the knife, to shrink from an op- 
eration, to fear pain, — is there a more universal instinct? 
It is next to the vital instinct of self-preservation. What 
iron will, what previous agony, must induce that forti- 
tude which can bring the sufferer to lie down and be cut 
without stirring ! 

All this is annulled by anaesthesia. How much mental 
shock is thus removed ! 

What is surgically termed the " shock of the opera- 
tion," or the disturbing effect on the nervous system of 
violence done the flesh and nerves, is also largely dimin- 
ished. Anticipation is done away with ; pain is pre- 
vented ; shock is reduced. 

41 



what has The patient consents to operation earlier ; he does not 

done for wait until life becomes unbearable, but calmly contem- 

plates surgery as the natural and easy channel of relief. 
Hence his chances of benefit from an operation are 
much increased; he averts destructive processes, short- 
ens disease, is more likely to recover. So much is done 
for the patient. 

To the surgeon anaesthesia gives the patient asleep, 
motionless, senseless. He need not hurry ; he need not 
sympathize ; he need not worry ; he can calmly dissect, 
as on a dead body; heedful only that the etherizer is 
competent, the breathing and pulse watched, the opera- 
tion not prolonged beyond the verge of exhaustion. 

The surgeon, then, can do better work; he can be more 
careful ; he can pause and consider ; he can choose his 
steps ; he can be deliberate, if not dexterous. He can 
even summon the aid of the pathologist and his micro- 
scope, who in ten minutes, while the patient sleeps, can 
decide the nature, the innocence or malignancy, of the 
tumor he is removing. 

It is also just to believe that the moral fibre of the sur- 
geon is less strained; judicial callousness is no longer 
called for; he need not steel his heart, for his victim 
does not feel. 

For surgery and for diagnosis, anaesthesia has done 
even more. It has enlarged its domain by rendering 
justifiable, and even promising, severe and delicate oper- 
ations. 

The tyranny of misguided conscience drove the inquis- 
itors of the Middle Ages to rack the joints apart : so, 
too, the surgeon was formerly obliged to use the rack to 
tire the muscles and disrupt the capsule, to reduce a dis- 
location. Now anaesthesia relaxes the muscles, and 
manipulation rolls the bone into the socket. 

Homeric strength was needed to bear Homeric sur- 

42 



gery. Strong men and calm women endured desperate what has 

. . ANESTHESIA 

mutilations and recovered. But at what a cost ! done for 

Such surgery must necessarily have been largely trau- SUR,jrERY 
matic, or the result of emergencies threatening death if 
not relieved. 

It is not too much to say that all the finer work of 
plastic, conservative, and abdominal surgery dates from 
the discovery of anaesthesia. It could not have been 
done before. Neither surgeon could persist, nor patient 
endure it. Perhaps one thousand ovariotomies were 
done by Sir Spencer Wells before asepsis was much 
practised, but they were all done since anaesthesia was 
known. The tedious details in a radical cure of hernia 
were mostly mechanical before anaesthetics, and the oper- 
ative measures have been adopted since. 

Formerly the surgeon was estimated for dexterity and 
quickness. Now he is esteemed the great surgeon who 
to judgment adds dexterity, and to dexterity patience. 

Anaesthesia was the necessary precursor of asepsis. 
Without the former the latter would not be what it now 
is. Even if antiseptic agents were used in dressing 
wounds, the operations which caused the wounds could 
not have been done aseptically without anaesthesia. 

The essence of asepsis is detail, tedious rules and pre- 
cautions, prolonged and accurate dressings. All this 
requires time, immobility, unconsciousness. To stitch 
the most delicate tissues with accuracy, to match the 
bowel or bladder so that it will not leak, — how could 
this be done on a conscious and quivering patient ? 

First, anaesthesia ; second, asepsis. They must be in- 
separable for success. 

All visceral surgery, which deals with the great serous 
cavities, and which constitutes the proud distinction of 
modern surgery, depends on anaesthesia first, and on asep- 
sis afterward. The latter is as beneficent a discovery as 

43 



what has the former. Hand-in-hand, equal benefactors, anaesthesia 
done T for and asepsis march calm and triumphant. Together 

surgery ^y j iave altered life, enlarged what is worth living for, 

postponed death. May we not claim now as fulfilled for 
surgery that old saying which our fathers regarded as the 
acme of success and skill in curing the patient, Tuto, 
cito et jucunde (Without danger, without delay, without 
pain) ? 

Is there no reverse to this brilliant picture ? There is 
if we allow it, but most dangers and mischances can be 
averted by care. The danger of immediate death from 
anaesthetics is no greater than the ordinary risks of life 
in the daily pursuits of civilized communities. The use 
of power, whether steam or electric, surrounds the life of 
cities with hourly perils ; and the chance of succumbing 
under the inhalation of ether is no greater than the risk 
of a street accident or a railway journey. Of those who 
inhale sulphuric ether, about one in fifteen thousand die. 
I formerly believed that chloroform was ten times more 
fatal than ether; larger statistics have modified that 
opinion, and it may now be fairly stated to be five times 
more dangerous, or of those who inhale chloroform about 
one in three thousand die. 1 

Since neither anaesthetic is given to the well and sound 
person, but always to the sick or injured, we cannot 
eliminate the chances of death from inhalation, which 
may be increased by infirm hearts, lungs, or kidneys. 
The patient is forced to take those chances. And yet 
how few perish from these pain-dispelling agents ! 

An elementary alcohol, sulphuric ether acts like alco- 
hol in its effects when inhaled. A quickened pulse, a 
stimulated heart, a vivid capillary blush, congestion of the 
brain, mental exhilaration, confusion, intoxication, a leth- 
argy which is not lethal. 

1 Appendix I. 
44 



Ether is fatal unless breathed with the oxygen of at- what has 
mospheric air ; nay, more, provision to have the carbonic done T for IA 
acid exhaled must also be provided for. An uncovered SURGERY 
sponge for an infant, and a sponge covered with a porous 
towel for the adult, are still among the best — and surely 
the safest — inhalers: rigidity, lividity, stertor, only em- 
phasize the need of more air. 

Chloroform affects the heart more suddenly and surely 
than the respiration. It is a heavier gas, pleasant to 
take, less bulky, quicker in producing unconsciousness, 
less irritating to the lungs, less followed by vomiting; 
but, when fatal, suddenly fatal, without premonition. Its 
primary effect is depressing ; the skin is cool and pale ; 
the pulse not stimulated ; sleep follows speedily. 

The distinction of danger from safety in the inhala- 
tion of both anaesthetics may be described in the words 
of Shelley : — 

" How wonderful is Death, 
Death and his brother Sleep ! 
One pale as yonder waning moon, 
With lips of lurid blue ; 
The other rosy as the morn 
When, throned on ocean's wave, 
It blushes o'er the world." 

A secondary danger is from prolonged anaesthesia. 
Sulphuric ether inhaled the first half hour is stimulant ; 
the second half hour, tolerable ; the third half hour, de- 
pressant. The pulse creeps up from the eighties to the 
one hundred and twenties ; the skin cools ; color fades ; 
sweat rains from the surface ; respiration becomes shal- 
low or sighing, — all signs of exhaustion, collapse, and 
death. Intent on a delicate, and as he thinks necessary 
and final, step in his operation, the surgeon may persist 
too long, and the patient sink too low for recovery. This 
danger is emphasized by the delays of aseptic precau- 

45 



what has tions, of minute embroidery of serous membranes with 
done for sutures, of too long an exposure of the vital cavities. 

surgery j± common, but not constant, effect of the inhalation 

of ether, and of chloroform to a less degree, is nausea and 
vomiting, both while asleep and after wakening. If only 
of brief duration, its only danger is in disturbing the 
wound, as the humors of the eye or the ligatures on the 
pedicle of an ovarian cyst. This danger is, however, to 
be counted. If of long duration, it marks a condition of 
secondary shock, which is often fatal. 

No agent has been found to be a specific to prevent 
vomiting. An empty stomach is an essential in inhaling 
anaesthetics. As remedies, the bromides, the subcutane- 
ous injection of morphia and atropia, the inhalation of 
oxygen, have each given a certain success. Much vomit- 
ing may be prevented by giving ether only to the verge 
of insensibility; not filling the blood too full of the 
vapor ; taking the ether off permanently as early as pos- 
sible ; for unconsciousness persists for fifteen to twenty 
minutes after apparent rousing, and the patient's motions 
and moans are automatic, and not remembered after 
waking. 

Sulphuric ether irritates the mucous membrane of the 
bronchi and minute air-passages. We know how it con- 
gests the eyes if it runs into them. It provokes a large 
and sometimes dangerous secretion of sero-mucous fluid 
from the bronchi ; this gets churned up with air, and fills 
the throat with a bubbling-fluid like soapsuds. It is both 
annoying and dangerous. Chloroform causes much less 
of this condition. 

Acute bronchitis, pulmonary edema, broncho-pneumo- 
nia (but not true lobar-pneumonia) * may follow, and turn 
the scale against the patient. It is claimed that a previ- 
ous injection of atropia will often dry the throat and 

1 Appendix II., Dr. Prescott. 

4 6 



bronchi, and avert this excessive secretion. Light inha- what has 
lations, plenty of air, watchfulness to swab the throat, done T f<xr IA 
care to remove the ether early, are the best remedies. surgery 

Both sulphuric ether and chloroform congest the kid- 
neys, and produce albuminuria in more than one half the 
cases. 1 This albuminuria is usually of short duration ; 
but one can readily see that a diseased kidney might be 
overwhelmed by it, just as a feeble heart would suc- 
cumb to chloroform, or diseased lungs to an increased 
bronchial secretion. Bright's disease, diabetes, any in- 
flammation of the air-passages, pleuritic effusion, acute 
bronchitis, valvular disease of the heart, croup, — all are 
unfavorable conditions for an anaesthetic. 

The thermo-cautery about the face demands chloro- 
form. 

If in spite of these unfavorable conditions only one 
person in fifteen thousand succumbs to the inhalation of 
ether, we may conclude that we shall not find a safer 
agent to produce unconsciousness, though we may a 
more agreeable. 

1 Appendix III., Dr. Blake. 
47 



** 



WHAT HAS 
ANESTHESIA 
DONE FOR 
SURGERY 



APPENDIX 



I. Mortality 

Combined statistics of Gurlt, of Berlin, and Juillard, of Geneva : — 
Chloroform. — 691,319 cases, 224 deaths. One death in 3,082 
cases. 

Ether. — 341,058 cases, 23 deaths. One death in 14,828 cases. 

II. Lungs 

Prescott believes that ether cannot produce true lobar pneumonia. 
He gives only two cases in about 40,000 ether inhalations. 

Boston Medical and Surgical Journal, March 28, 1895, vol. cxxxii. 
No. 13, p. 304, W. H. Prescott, M. D. 



III. Kidneys 

Examination of 50 cases, before and after ether. Urine filtered, 
and nitric-acid test used. In 36 cases out of 50, ether produced albu- 
min, or increased that already existing. But the German authorities 
believe that chloroform irritates the kidneys more than ether. Albu- 
min after ether was slight in amount and of short duration. 

Second Lyman Prize for 1894, John Bapst Blake, M. D. Boston 
Medical and Surgical Journal, vol. cxxxii. p. 560. 

48 



- 



RELATION OF ANyESTHESIA 
AND OBSTETRICS 

BY JOHN P. REYNOLDS, M.D. 
OF BOSTON 



RELATION OF ANESTHESIA AND 
OBSTETRICS 




N the welcome that greeted anaesthesia in 
this city fifty years since, its promise to 
women in labor was not overlooked. Oli- 
ver Wendell Holmes, recounting its bless- 
ings, rejoiced that it lifted " the primal 
curse ; " Walter Channing, our honored first professor of 
midwifery, devoted an important volume, his " Etheriza- 
tion in Childbirth," to its early triumphs. To-day, after 
the half century, it is my glad office to lay before you 
the priceless worth of anaesthesia in obstetrics. 

In operative obstetrics, in the high and difficult use of 
instruments, in the introduction of the hand for version 
and extraction, anaesthesia resembles at all points that of 
the graver procedures of general surgery. It brings the 
same admirable results: a patient in blissful unconscious- 
ness ; an operator delivered from all concern for another's 
suffering, with ample time for exact and thorough diag- 
nosis, and free to work with all desired accuracy, deli- 
cacy, and caution. In obstetrics there is often a further 
gain of great moment: loosing the formidable grip of the 
uterine muscle. Mention must also be made of the 
induction of premature labor, in which the power of 
safely maintaining for many continuous hours profound 
etherization is rapidly securing for the method of passive 

51 



relation of manual dilatation a deserved preeminence. It may be 
and obstet- added that five minutes only of deep anaesthesia, rapidly 



RICS 



induced, prove at times no mean resource in softening 
the thin, wiry edge of a tardily dilating uterine mouth. 
After profound anaesthesia during delivery, increased 
watchfulness against hemorrhage is always wisely en- 
joined ; but where the precautions which are in all labor 
indispensable are duly enforced, any added risk is per- 
haps rather inferred than proven. 

The service of ether in puerperal convulsions is still 
more striking. Used in the manner now to be described, 
it prevents any new seizure. An eclamptic patient is 
brought with all possible rapidity to complete uncon- 
sciousness. During many consecutive hours this is 
firmly kept up, always under strictly professional care ; 
there can be no delegation of the physician's authority to 
any hands less qualified than his own, not even to those 
of the best trained nurse. An utterly passive condition 
is secured ; and then, on the least restlessness, agitation, 
indication of pain or uneasiness in any region, — above all, 
at any slightest tremor of an eyelid, or other known pre- 
monition of afresh attack, — the remedy must be instantly 
pushed to full, snoring anaesthesia. No evil effects will 
ensue from continuing this state for many successive 
hours, and these can seldom be fewer than eight or 
ten. Under anaesthesia food is, of course, withheld. It 
must be distinctly understood that such an employment 
of ether has no power of cure. In exhibiting it we abso- 
lutely prevent fresh paroxysms, each of which strikes a 
new blow at the brain and nervous centres, and we gain 
at the same time the all-precious opportunity for treat- 
ment. This latter must be meanwhile actively pressed : 
first and foremost, unless already accomplished, the emp- 
tying of the uterus ; to temporize with that does no good 
whatever, and may bring incalculable harm. Improve- 

52 



ment in the renal condition is the best proof of amend- relation of 
ment. When to withdraw the ether is always a most and S obst S et- 
anxious problem, steady continuance of it being in all RICS 
doubtful cases the far safer alternative. 

In making these strong assertions in regard to ether- 
ization in eclampsia I weigh well my words. Carelessly 
or ignorantly followed, they may work mischief. But the 
subject is of extreme importance. In my results there 
has not been the slightest variation, and I am confident 
that I do not stand alone. The time has come to pre- 
sent these views to the medical profession, and to press 
their general acceptance. 

For the prolonged use in eclampsia just described, and 
even for that already suggested in the induction of pre- 
mature labor, I dare not approve chloroform. 

Would that any words of mine could bring home, as 
I feel it, the inestimable blessing of ether in all labor, 
silence groundless excuses for its neglect, and so rouse 
professional interest that no one should lightly forbid it 
to any woman in childbed ! " Bless God for ether!" has 
burst from the lips of thousands on thousands of suffer, 
ing women. It might well be made the cry of countless 
thousands more. 

In normal labor due anaesthesia is free from every 
shadow of danger. The alleged after-evils do not exist ; 
on the contrary, the gain in safety outweighs the expres- 
sible comfort and relief. It is indispensable that the 
anaesthetic be administered only within the limits now to 
be laid down ; on this is conditioned the truth of all that 
follows. 

Ether, when properly given in normal obstetrics, never 
contents the patient. She incessantly cries for more, 
and, if in first labor, indignantly claims to be forthwith 
put asleep, and to know nothing till after the birth. The 
anaesthetic is allowed only during the uterine contrac- 

53 



RELATION OF 
ANESTHESIA 
AND OBSTET- 
RICS 



tion,— the time of positive pain. In the interval it is 
withdrawn. Consciousness should then return, and there 
is often intelligent speech. Ether may be given at any 
period, and might be continued from the beginning of 
labor to its close. There should be here no question of 
the so-called " stages " of labor. Only one rule governs 
its use. Whenever the attendant sees that the woman's 
endurance of pain begins to tell upon her patience and 
courage, the moment for ether has come. It is to be 
kept up so long as this need lasts ; no longer. In an 
appreciable minority of cases, a mother who in her early 
suffering has been clamorous for relief will herself, when 
the so-called "real" pains appear and conscious pro- 
gress is made, put it away : " I can do without it now." 
On its first employment, a lull often comes in the uterine 
action, the patient sinking into a much-needed repose, 
to which soon succeeds a yet more vigorous advance. 
The extremely rare case in which no such renewal occurs 
must plainly forego anaesthesia. It should be noted that, 
in the earliest pains, some careful observers hold that 
chloral in suitable doses gives still greater relief. 

With even these limitations, the value of ether can 
hardly be overestimated. It is something that in the 
distress a good and decorous deportment is no longer 
enjoined ; it is everything that tender hands can now, as 
in other nursing, solace each access of suffering with 
positive help ; but far, far beyond this, that we thus up- 
hold in the patient that vital resistance which mental and 
nervous tension and the long endurance of pain, more 
than all other causes combined, destroy, — that which 
soothes becoming likewise a chief guarantee of safety, a 
help against hemorrhage. 

Unhappily, a frequent resort to ether may not be asked 
from lying-in hospitals and the great public charities. 
These establishments, burdened with enormous and ever- 

54 



enlarging: cost for the first needs of the destitute, — shel- relation of 

r j *.!. ' 4- J J *.u i. • ANESTHESIA 

ter, food, warmth, nursing, — cannot add the great in- and obstet- 
crease of responsible attendants which general anaesthesia RICS 
would require. But, even for private practice, anaesthetics 
are not, in simple labor, extensively used. The medical 
profession does not accept what has just been said of 
ether. Its benefits are sturdily denied. Men declare 
that it promotes flooding; that it wastes important time; 
that it presents them, in place of a woman bearing her 
pain with dignity and fortitude, a creature regardless of 
appearances and only clamoring every moment for ease. 

These charges come mainly, I believe, from those 
who, under varying motives, content themselves with a 
tardy, perfunctory, or even deceitful resort to ether ; 
" refusing it," as women sometimes say, " when we most 
need it, and allowing it when we could most easily do 
without it." Later, one may readily ascribe to the anaes- 
thetic, which has in no true sense been tried, those com- 
mon disasters of childbed which its proper use would 
largely ward off ; and these assertions, once made, sup- 
ply a ready excuse for that numerous, and it is to be 
feared increasing class who do not so much oppose ether 
as willingly evade and neglect it. 

We have seldom possessed an accoucheur of wider 
experience, or a teacher of greater gifts of tongue and 
pen, than the late famous Fordyce Barker, of New York. 
Several years ago, I listened with eager interest as he, 
in this city, before the American Gynecological Society, 
deeply condemned the growing disuse of ether in obstet- 
ric practice. " Through a long series of years," he said, 
" I have rarely attended labors without ether. I have 
never seen from it any evil effects. Especially has it 
not caused a tendency to hemorrhage. Indeed, I should 
say that instances of flooding that I have seen have 
rather occurred in cases where ether had not been em- 

55 



relation of ployed." Years have but deepened my conviction of 

ANAESTHESIA 

and obstet- the exact truth of the words that I then so heartily wel- 
RICS corned. 

The time of an obstetric attendant is no longer his 
own ; he may not condemn the extra half hour that ether- 
ization will now and then compel His approval or his 
dislike of his patient's attitude in her distress is of trivial 
importance. Objections like these have no weight unless 
urged by the sufferer. She was never known to advance 
them. 

The charge that anaesthesia increases flooding cannot 
be thus lightly set aside. As matter of opinion it has 
been to-day claimed that the due use of ether saves the 
mother's courage and strength; that, it preserves, not 
breaks down, uterine contractile power ; that it thus les- 
sens the risk of hemorrhage. It will be found that clini- 
cal facts do not belie this theory. They wait for other 
observers as they did for Barker. Those in search of 
them are prayed to make trial of ether in all confine- 
ments, not, indeed, forgetting the due limitations, but 
ungrudgingly, thankfully, gladly. 

One remembers tender hearts that doubted their right 
to evade, under ether, Heaven-sent pain. How marvel- 
lously the words graven beneath our cherished Ether 
Memorial send down, in reply, their adoring praise ! — 

" This also cometh forth from the Lord of Hosts, who 
is wonderful in counsel and excellent in working." 

56 



THE INFLUENCE OF ANAESTHESIA 
UPON MEDICAL SCIENCE 

BY W. H. WELCH, M. D., LL. D. 
OF BALTIMORE 



THE INFLUENCE OF ANESTHESIA 
UPON MEDICAL SCIENCE 




R. PRESIDENT, Gentlemen of the Board 
of Trustees and of the Medical Staff of the 
Massachusetts General Hospital, Ladies 
and Gentlemen : Five months ago was cel- 
ebrated the centennial anniversary of that 
grand discovery by Jenner which brought under subjec- 
tion the most prevalent and horrible scourge of former 
centuries. To-day we have assembled in this famous 
hospital on the very spot, made memorable for all time, 
where fifty years ago William Morton first demonstrated 
to the world the art of surgical anaesthesia, the happiest 
gift ever conferred upon mankind by medical science or/ 
art. We may add to vaccination and anaesthesia the more 
recent introduction of antisepsis by Lister ; and we can 
truthfully say that all the previous centuries can show no 
achievement of the art of the physician or surgeon com- 
parable in beneficence to any one of these triumphs of 
the last hundred years. 

It is in consequence of their enduring utility and ben- 
efit to humanity that these discoveries, which have led to 
the mastery over a pestilence, the annulment of pain, and 
the safe healing of wounds, merit the everlasting grati- 
tude of the world. But it is fitting on such a commem- 
orative occasion as this that, while these practical aspects 
receive their due consideration, we forget not the debt 

59 



s 



the influ- which these great discoveries owe to science, nor the 
anesthesia debt which science owes to them. It is, therefore, most 
science EDICAL appropriate that those who arranged the programme to 
commemorate this fiftieth anniversary of the first public 
demonstration of surgical anaesthesia should have chosen, 
as one of the themes to be here presented, " The Influ- 
ence of Anaesthesia upon Medical Science." Their wis- 
dom I am sure was less conspicuously manifested in their 
selection of the medium for the presentation of this sub- 
ject, highly as I esteem the honor of being invited to 
speak upon this occasion. 

In the limited time allotted to an individual speaker, I 
cannot hope to do more than to present in outline some 
of the salient aspects of my theme. 

I shall not attempt to trace the history of the dis- 
covery of surgical anaesthesia, a history which affords a 
lamentable illustration of how the awards of generous 
gratitude may be sacrificed to fruitless efforts to mete 
out equal and exact justice. I wish in this connection 
to call attention only to the fact that this discovery was 
made in the only way in which it possibly could have 
been made, and that is by the method of experimenta- 
tion. The opponents of animal experimentation have 
endeavored to utilize for their purposes the alleged ab- 
sence of experiments upon animals as the basis of this 
discovery. As a matter of fact, even leaving out of 
account the pioneer experiments upon animals by Hum- 
phry Davy with nitrous oxide, the first successful trial 
of ether as a- general anaesthetic for human beings by 
Morton was preceded by his demonstration of the power 
of this agent to produce in dogs unconsciousness and 
insensibility to pain. It would be strange, indeed, if 
these striking results of experiments upon animals had 
no influence in inducing him to test their applicability to 
human beings. 

60 



It must, however, be admitted that the production of the influ- 
anaesthesia in man by inhalation of ether was not pre- anesthesia 
ceded by such numerous and properly conducted experi- science DICAL 
ments on animals as were required to afford any adequate 
conception of its effects or its possibilities of danger. 
We now know that such experiments would have yielded 
knowledge of this character. We know also that the 
anaesthetic sleep induced by ether in man as well as 
in animals is not attended with more than a minimal 
amount of danger ; but suitable experiments upon ani- 
mals would have afforded more knowledge than Morton 
could have possessed as to whether there was to be sure 
awakening from that sleep so like unto death. Hence 
it is that, when that patient fifty years ago to-day in this 
hospital was placed under the profound influence of 
ether, he was made the subject of a scientific experiment 
of immense practical import and of unsurpassed bold : 
ness. This was the decisive experiment from which" 
dates "the continuous and consequent history" of anaes- 
thesia. 

The discovery of surgical anaesthesia is, I repeat, a tri- 
umph of the experimental method, albeit man himself 
was made the subject of experiment and thereby exposed 
to unknown possibilities of danger. 

If my theme embraced the consideration of all of the 
relations of artificial anaesthesia to medical science, and 
did time permit, it would be proper for me to direct 
attention to the part played by animal experimentation 
in the discovery and introduction of new anaesthetics, 
and to the numerous physiological and pharmacological 
experiments, mainly upon animals, which have shed so 
much light upon the mode of action of aaensthetics, par- 
ticularly of ether and chloroform, and the sources of 
danger in their employment. Although not all of the 
questions involved have yet been solved, these experi- 

61 



the influ- ments have furnished a large amount of knowledge of 
anesthesia great scientific value and of much practical interest 
science EDICAL concerning the properties of anaesthetics, — knowledge 
which it is certainly desirable to possess, and much of 
which could not have been gained otherwise than by ex- 
periments upon animals. 

I might speak also of the broad biological interest 
which attaches to the universal susceptibility of living 
matter to the sleep-producing influence of ether and chlo- 
roform, a susceptibility extending even to vegetable cells 
and the simplest unicellular organisms; also of how the 
gentle killing of certain bacteria by chloroform enables 
us to detect in their bodies toxic substances which are 
destroyed by more violent modes of death ; and further of 
interesting properties of nerve and of muscle which have 
been revealed by studying under various conditions the 
action upon them of anaesthetic agents. But I do not 
interpret the subject assigned to me as including the con- 
sideration of such matters as these, interesting as they 
are, and it is certain that time would not permit even 
their sketchy presentation upon this occasion. 

What I especially desire to emphasize in these brief 
remarks is, that the utility of the discovery of anaesthetics 
is not limited to their practical application to the surgi- 
cal and medical and obstetrical arts, but that this discov- 
ery has been of great service also to medical science, upon 
which these arts in large part rest. 

Anaesthetics appeared upon the scene at a time when 
the experimental medical sciences were entering upon 
an epoch of activity and success far surpassing anything 
previously known in the history of medicine. The 
shackles of philosophical speculation and dogma which 
bound medicine at the opening of this century had been 
broken by the work of such men as Bichat, Magen- 
die, Johannes Mliller, Rokitansky, Laennec, and Louis. 

62 



Their work was based upon exact observation and exper- the influ- 
iment, and there had come to be a general realization of anesthesia 
the fact that these are the only trustworthy sources of science EDICAL 
knowledge. Animal experimentation, which, as a fruit- 
ful method of investigation, began with Harvey's discov- 
ery of the circulation of the blood, had in the hands of 
Charles Bell, Magendie, Muller, and others yielded abun- 
dant proofs of its value. It was during the fourth decade 
of this century that those great experimenters, Claude 
Bernard, from the school of Magendie, and Du Bois- 
Reymond, Helmholtz, Briicke, and Ludwig, from the 
school of Muller, started their epochal investigations in 
physiology. It was at the same period that Virchow 
and Traube began those researches which established 
animal experimentation, already successfully employed 
by John Hunter, as a most important aid in the devel- 
opment of pathological physiology. It was then also 
that experimental pharmacology, which had been inau- 
gurated by Magendie, was first cultivated as a distinct 
branch of medical science by Buchheim. The need of 
suitably equipped laboratories where experimental inves- 
tigations could be conducted was now felt more keenly 
than ever before. By being the first to supply these es- 
sential instruments of fruitful scientific activity, Germany 
took the lead in scientific discovery, a position w,hich 
her enlightened policy in the establishment and support 
of laboratories has enabled her ever since to retain. 

The introduction of artificial anaesthesia came at this 
auspicious period of awakened activity, which gave such 
promise of the rapid development of scientific medicine 
through the aid of exact observation and experiment. 
And how brilliantly has this early promise been fulfilled 
by the discoveries of the last fifty years, which have wit- 
nessed the creation of cellular pathology, the rapid devel- 
opment of physiology to a biological science of the first 



the influ- rank, conferring great benefits upon medicine, but extend- 
an^sthesia ing far beyond the boundaries of medicine the establish- 
science EDICAL ment of pharmacology upon a broad scientific basis; and 
the birth of the science of bacteriology, which has un- 
locked the gates to new fields whose brief exploration has 
already proven of such immense importance to preventive 
and curative medicine and practical surgery ! It is true 
that, when we consider all that we may reasonably hope 
to learn concerning the structure and functions of living 
beings in health and in disease, and how they may be 
influenced for good or for ill, only a corner of the curtain 
has been lifted ; but when we compare the advance of 
medicine during the last fifty years with what was previ- 
ously known, we can truthfully say that this advance has 
been greater during these years than during all the pre- 
vious centuries. 

A large and important part of this progress is attribu- 
table to the results obtained by means of experiments 
upon animals. One has only to imagine blotted out 
from the records of physiology, pathology, pharmacol- 
ogy, hygiene, bacteriology, and other medical writings 
all of the facts which have been derived from animal 
experimentation to realize how immense would be the 
loss to both scientific and practical medicine had inves- 
tigators been deprived of this indispensable method of 
research. To point out in detail how broad and deep 
would be this gap cannot be even attempted in the short 
time here allotted, and would be surely unnecessary be- 
fore this audience. 

The use of anaesthetics has been such an important 

aid in the performance of these experiments upon ani- 

; mals during the past fifty years that it is eminently fitting 

I on this jubilee that medical science should also pay its 

tribute to the beneficence of the great discovery here 

celebrated. 

6 4 






The ways in which anaesthetics have been serviceable the influ- 

. J . .,,... . ENCE OF ! 

to animal experimentation are essentially similar to those an^esthe&ia 

,.,,ii i r, i UPON MEDICAL 

in which they have benefited surgery. science 

The great majority of painful vivisectional experiments 
upon the higher animals are of such a nature that the 
object of the experiment is not defeated by the employ- 
ment of anaesthetics. In experiments of this class, all 
trained experimenters should and do use anaesthetics, and 
there is no evidence that there exists to-day any abuse 
of vivisection on this score in any properly conducted 
laboratory. The dictates of humanity demand that we 
shall gain, for the benefit of man, knowledge which can 
be acquired only from experiments upon animals ; and 
they demand also that this knowledge shall be gained 
without the infliction of needless suffering. Humane 
instincts are not less active among those who devote 
themselves to acquiring knowledge in this way than 
among other classes of men, but these instincts in the 
former are controlled, not by false sentiment but by 
reason and duty. It is a source of immense gratification 
to experimenters, as it should be to all with humane im- 
pulses, that, in consequence of the discovery of artificial 
anaesthesia, so large a part of the useful knowledge which 
can be derived only from experiments upon animals can 
now be acquired without the infliction of pain. To 
cite the animal experiments of pre-anaesthetic days, as 
for example those of Magendie, as illustrations of pres- 
ent methods of experimentation, is as unwarrantable as 
would be a similar procedure in describing surgical oper- 
ations. 

The advantages of anaesthesia are not limited by 
the mere abolition of pain. In animal experimentation, 
as well as in surgery, the insensibility to pain and the 
cessation of voluntary movements induced by anaes- 
thetics have rendered many operations easy which would 

65 



the influ- otherwise have been difficult, many practicable which 
anesthesia would otherwise have been impossible. The success 
science EDICAL °f tne experiment is made much more certain when the 
operator can work at ease and without undue haste, 
undisturbed by the thought that he is inflicting pain. 
There are physiological experiments which, so far as I 
am able to judge, make greater demands upon the pa- 
tience and operative skill and delicacy of manipulation of 
the operator than any in surgery, and these never could 
be performed upon a sensitive and struggling animal. 
Sensations of pain are in themselves a disturbing factor 
which would defeat the purpose of not a few delicate 
physiological experiments. The experiments to deter- 
mine the functions of the brain, which have yielded 
results of great importance to practical medicine and 
surgery as well as to science, may be mentioned as one 
out of many illustrations of this fact. The antiseptic 
management of wounds, which is essential to the success 
of some experiments and which alleviates subsequent 
suffering when it is necessary that the animal should 
survive the experiment, is greatly facilitated by the use 
of anaesthetics. 

I trust that I may be pardoned if I pause here for a 
moment to correct a misconception which does not exist 
among well-informed medical men, least of all among 
practitioners of medicine, but which plays a considerable 
role in anti-vivisection literature. I refer to the distinc- 
tion there made between the use of anaesthetics and that 
of narcotics for the purpose of rendering animals insen- 
sible to pain. So far as the point in question is involved, 
this distinction is ridiculous, and seems to be based upon 
a misunderstanding of some old physiological experi- 
ments. For prolonged experiments it is often advan- 
tageous to place the animal in the sleep induced by 
morphine or chloral, instead of that of ether or chloro- 

66 



form. These drugs are administered in much larger the influ- 
doses, and often in different ways, than is customary in anesthesia 
human beings. That under these circumstances the ani- sci^nc^ EDICAL 
mal is rendered insensible to pain is a fact the knowledge 
of which might have been gained from ordinary medical 
experience. 

Curara is a drug which has important uses in a cer- 
tain class of experiments upon animals. It has never 
been claimed by any scientific man that it is an anaes- 
thetic, although it has been found capable of affording 
great relief from pain in some spasmodic affections of 
human beings. Its use has led to important physiologi- 
cal discoveries which could not well have been made 
without it, and in a limited class of cases its employment, 
either with or without the coincident administration of 
anaesthetics, is indispensable. 

There are, of course, experiments upon animals in 
which there is no occasion to employ anaesthetics. Ani- 
mal experimentation and vivisection are not coextensive 
terms. There is a large group of experiments, mostly 
of a painless character, in which there is no cutting, or 
other operative interference whatever with the animal. 
Here belong many of the experiments upon metabol- 
ism, upon diet, upon the fate of drugs, etc. There are 
others in which the operative act is so slight or tran- 
sitory that the animal would suffer far more discomfort 
from the administration of an anaesthetic than from the 
operation itself. There are, finally, painful vivisection 
experiments, relatively few in number, however, whose 
purpose would be defeated by the use of anaesthetics. A 
striking example of such an experiment is that of Charles 
Bell in determining the motor and sensory functions of 
the nerve roots of the spinal cord, an experiment which, 
with those of Galvani, laid the foundations of modern 
nerve physiology. 

67 



the influ- Experiments upon animals have been and must con- 

an^sthesia tinue to be an indispensable aid to the progress of scien- 
science EDICAL tifi c an< ^ Poetical medicine. In the performance of a 
large number of these experiments the use of anaesthetics 
is of priceless service. I trust that without presump- 
tion I may here express, in behalf of the great body of 
scientific workers in medicine throughout the civilized 
world, their feelings of gratitude for the great boon con- 
ferred upon medical science by the discovery of artificial 
anaesthesia, which, in the form of a safe, useful, and ef- 
fective method, was first promulgated from this hospital 
fifty years ago to-day. 

68 



THE SURGERY OF THE FUTURE 



BY CHARLES McBURNEY, M. D. 
OF NEW YORK 



THE SURGERY OF THE FUTURE 




E worship to-day at the shrine of the God- 
dess of Anaesthesia, whose gentle sway 
over the surgical world of all civilized 
countries has so beneficently displaced the 
reign of terror which existed only two gen- 
erations ago. What anaesthesia has done for surgery 
has been already most eloquently told, and we all realize 
that without it the best of modern work would be impos- 
sible. 

It seems but yesterday, and yet it is already a matter 
of history, that the wonderful discovery of the aseptic 
treatment of wounds was given to us, through whose 
agency countless thousands of human lives have been 
preserved. 

Through these two discoveries surgery has become a 
gentle art : for the agonies of operations and the fatal 
diseases of wounds have given way to a painless sleep, 
and an awakening to a safe recovery. And bacteriology, 
which in its infancy gave birth to aseptic surgery, has 
penetrated with its brilliant light a darkness which our 
predecessors believed would last forever. 

So generous, indeed, has the recent past been to sur- 
gery with gifts which make our science rich almost be- 
yond belief, that the future may well be modest in telling 
us what it will do. It would almost seem as if the toil- 
some ascent had been accomplished, and as if the future 

71 



the surgery could hold for us no obstacles that could tax our powers. 

future That such a comfortable view is not shared by the ever- 

active surgical worker and his numerous collaborators is 
fortunate, and we are thus assured that difficulties, per- 
haps not so large as those already conquered, but both 
grave and numerous, will, by increasing effort, be swept 
away and relegated to the past. 

It seems to me that in the immediate future the great- 
est surgical victories are to be won by the aid of bacteri- 
ology, which has already unlocked so many mysteries. 
Through it diphtheria and tetanus have been brought 
within the list of frequently curable diseases. Why 
should we not soon be able to say even more of general 
sepsis, tubercle, and cancer ? We have already reached 
a high degree of perfection in preventing the entrance 
of sepsis through the surgical or the accidental wound ; 
but, given a case where sepsis has already deeply invaded 
the body, through whatever point of entrance, and we 
are well-nigh helpless. We may empty an abdomen of 
pus, and even remove the cause of the disease, but we 
know nothing in regard to overcoming the sepsis already 
widespread throughout the body. Is it not in store for 
us that the discovery will soon be made by which we 
shall be able to destroy the sepsis-producing organism, 
no matter what its source, no matter how widespread ? I 
believe it is, and that we will, in the not distant future, 
be able to render the body immune to the existence of 
sepsis even of internal origin. 

All of the general surgeons, and many of the special 
ones, are devoting a large amount of their time to the 
treatment of tubercle. Operative surgery has attacked 
it very successfully, but we need the help of the bac- 
teriologist and of the physician to enable us to prevent 
its recurrence and to treat it in many localities. Surely 
the day is close at hand when the surgeon's knife, which 

72 



so readily removes the products of tubercle, will be aided the surgery 
by the remedy which destroys the bacillus itself. future 

Cancer in all its forms is still our worst enemy. Oper- 
ative surgery has done much, very much, to overcome it, 
aided by greatly improved diagnosis, and by means of 
more scientific and more radical operations. But the 
discovery of the true nature of the disease, the solution 
of the question as to whether it owes its existence to a 
living organism, and therefore one capable of death or 
not, are still in the hands of the future, and most eagerly 
awaited by all of us. The best energies of the bacteri- 
ological and the surgical world cannot be devoted to a 
worthier object. But the future of bacteriology is, and 
ever will be, in the hands of the most brilliant men, and 
surgery is destined to achieve many of its greatest tri- 
umphs through the aid of this ever-growing army of 
invaluable co-workers. With their help will the aseptic 
making and treating of wounds be brought to a far 
higher state of perfection than even the elevated one of 
the present day, and the exact reasons for disturbances 
in wound-healing, some of which are still but partially 
understood, will become part of the knowledge of every 
true surgeon. 

The possibilities for discoveries of enormous value to 
both the theory and the practice of surgery, through 
more perfect study of the blood, are certainly very large, 
and are already foreshadowed by what has been so re- 
cently learned in regard to the blood-corpuscles and the 
organisms of disease which invade and develop in the 
blood current. We may confidently expect through this 
means a very exact, and, what is of the utmost impor- 
tance, a very early diagnosis, in many surgical disorders 
which we now at first appreciate at a stage too late for 
efficient treatment. 

When one considers the very great value of the recent 

73 



the surgery addition to our resources, the infusion into the blood-ves- 
future se ^ s °f n °t saline solution, which has so beautifully sup- 

planted the difficult and dangerous process of blood- 
transfusion, one grows impatient for the day when at 
the same moment disease shall be drained from the body 
through one opened vessel, and life and health poured 
in through another. Some of us will see the day when 
death as a result of hemorrhage will be always avoid- 
able. 

In spite of the large contributions that have been 
made by scientific workers during the last few years, it 
may fairly be said that we have been living in an age of 
operative surgery, the growth of which has excited the 
interest and admiration of all classes of men. 

The public at large, and all branches of our profession, 
have become deeply infected with the idea that there 
are almost no limits to what can be done in the cure of 
disease by a skilful surgeon ; and the belief is much 
too widespread that almost any professional man, with a 
little knowledge of antisepsis, may properly practise 
surgery. This exaggerated feeling of confidence is the 
natural sequel to the discovery of asepsis, which, with its 
incalculable benefits, has scattered some harm. Every 
region and organ of the human body has been investi- 
gated by the operating surgeon, and far be it from me to 
say that this has not been wise and necessary. Conclu- 
sions cannot precede experience; and it has required 
courage, hope, and even blind faith, to explore and learn 
what we may accept and what we must discard. 

The operating surgeon of the future will have a most 
important and delightful task. Proud of his ability to 
do any operation, and to secure a perfect wound-healing 
with unfailing regularity, he will know when to withhold 
his hand. He will sacrifice his ambition to multiply the 
number of cases he has operated upon, and will devote 

74 



his energies to increasing only the number of those he the surgery 
has actually cured of disease. He will know better than future 
we do who are the actually moribund, and he will leave 
them untouched in the hands of the priest 

He will not be tempted by the plea that the patient 
must die as he is, and that therefore he should rightly 
be operated upon. He will not attempt to cure with the 
knife the poor little microcephalic child, or the advanced 
case of carcinoma of the stomach, uterus, or larynx. 
Our knowledge, acquired by much labor and sacrifice, 
will be his at the outset ; and the errors which we have 
made through over-enthusiasm will excite, not his con- 
tempt, but his gratitude. 

He will have at his disposal the large experience of 
the surgeons of to-day, and, unhampered by the views 
held in the pre-antiseptic era, he will draw conclusions 
and deduce principles sounder and clearer than our own. 

We may confidently look forward to vastly improved 
diagnosis of surgical disease, more especially such as 
will enable the surgeon to attack pathological processes 
in their incipiency. Especially in cases of malignant dis- 
ease is there much to be desired in this direction. Great 
advance has been already made in the wide removal of 
infected areas, and of the channels through which malig- 
nant disease is carried to other parts of the body. How 
much more efficient must such measures be when ap- 
plied at the very beginning of a cancer ! Perhaps we 
are justified in looking forward to such a development 
of the Rontgen light that the surgeon will be able to 
appreciate the location and character of all neoplasms 
while they are still young enough to be radically curable 
by operation. 

The future surgeon will enjoy a much closer and 
more intimate relation with his brother the physician 
than has ever existed between them before, for what be- 

75 



the surgery longs to medicine, and can be cured by surgery only, will 
future be far better appreciated by both surgeon and physician 

than it is to-day. 

Few operations will then be done as a last resort, for 
the only remedy that can cure in a given case will be 
eagerly demanded by the one and willingly applied by 
the other at the beginning of disease. 

Above all, Mr. President, will the surgery of the future 
attract to its enthusiastic study and practice finer and 
finer men, in whose hands we may safely leave the devel- 
opment of our science. A single glance at the faces of 
the students who collect daily in your operating-room 
will show you what a change has occurred in the last 
twenty-five years. For this, too, we must ever be grate- 
ful to anaesthesia, which, in removing the torture of sur- 
gery, has robbed it of what repelled many sensitive 
natures. And the science of asepsis, by rendering com- 
plete success in surgical work possible, will excite the 
most devoted enthusiasm from many scientific men, who 
soon would have become sick at heart over the failures 
of former times. What more attractive opportunity 
could possibly exist than will be offered by surgery to 
the well-educated, refined, able, and ambitious student? 
Through the vast experience of the recent past he will 
find many of the coarser problems already solved, and 
those that remain will stimulate him by their difficulty. 
He will be an accomplished anatomist and a physiolo- 
gist ; he will study medicine and pathology first, and then 
general surgery. If he specializes his practice, he will 
do so only after a large general experience ; and he will 
borrow from every science all that can contribute to the 
perfecting of his work. 

76 



THE BIRTH AND DEATH OF PAIN 

% $oem 

BY S. WEIR MITCHELL, M. D., LL. D. 
OF PHILADELPHIA 



THE BIRTH AND DEATH OF PAIN 




ORGIVE a moment if a friend's regret 
Delay the task your honoring kindness set. 
I miss one face to all men ever dear ; 
I miss one voice that all men loved to hear. 
How glad were I to sit with you apart 
Could the dead master use his higher art 
To lift on wings of ever lightsome mirth 
The burdened muse above the dust of earth, 
To stamp with jests the heavy ore of thought, 
To give a day, with proud remembrance fraught, 
The vital pathos of that Holmes-spun art 
Which knew so well to reach the common heart ! 
Alas for me, for you, that fatal hour ! 
Gone is the master! Ah ! not mine the power 
To gild with jests, that almost win a tear, 
The thronging memories that are with us here. 



The Birth of Pain ! Let centuries roll away ; 
Come back with me to nature's primal day. 
What mighty forces pledged the dust to life ! 
What awful will decreed its silent strife ! 
Till through vast ages rose on hill and plain, 
Life's saddest voice, the birthright wail of pain. 
The keener sense and ever-growing mind 
Served but to add a torment twice refined 
As life, more tender as it grew more sweet, 
The cruel links of sorrow found complete 
When yearning love, to conscious pity grown, 
Felt the mad pain-thrills that were not its own. 

79 



the birth What will implacable, beyond our ken, 

of D pain ATH Set this stern fiat for the tribeS ° f men ! 

This none shall 'scape who share our human fates : 

One stern democracy of anguish waits 

By poor men's cots, — within the rich man's gates. 

What purpose hath it ? Nay, thy quest is vain : 

Earth hath no answer : if the baffled brain 

Cries, 't is to warn, to punish — Ah, refrain ! 

When writhes the child beneath the surgeon's hand, 

What soul shall hope that pain to understand ? 

Lo ! Science falters o'er the hopeless task, 

And Love and Faith in vain an answer ask, 

When thrilling nerves demand what good is wrought 

Where torture clogs the very source of thought. 

Lo ! mercy, ever broadening down the years, 
Seeks but to count a lessening sum of tears. 
The rack is gone, — the torture chamber lies 
A sorry show for shuddering tourist eyes. 
How useless pain both Church and State have learned 
Since the last witch or patient martyr burned. 
Yet still, forever, he who strove to gain 
By swift dispatch a shorter lease for pain 
Saw the grim theatre, and 'neath his knife 
Felt the keen torture in the quivering life. 
A word for him who, silent, grave, serene, 
The thought-stirred master of that tragic scene, 
Recorded pity through the hand of skill, 
Heard not a cry, but, ever conscious, still 
In mercy merciless, swift, bold, intent, 
Felt the slow moments that in torture went 
While, 'neath his touch, as none to-day has seen, 
In anguish shook life's agonized machine. 
The task is o'er ; the precious blood is stayed ; 
But double price the hour of tension paid. 
A pitying hand is on the sufferer's brow, — 
" Thank God 't is over." Few who face me now 
Recall this memory. Let the curtain fall, 
Far gladder days shall know this storied hall ! 

80 



Though Science, patient as the fruitful years, the birth 

Still taught our art to close some fount of tears, A? D T ,R? T ATH 

OF PAIN 
Yet who that served this sacred home of pain 

Could e'er have dreamed one scarce-imagined gain, 

Or hoped a day would bring his fearful art 

No need to steel the ever kindly heart ? 

So fled the years ! while haply here or there 

Some trust delusive left the old despair ; 

Some comet thought flashed fitful through the night, 

No lasting record and no constant light. 

Then radiant morning broke, and ampler hope 

To art and science gave illumined scope. 

What Angel bore the Christ-like gift inspired ! 
What love divine with noblest courage fired 
One eager soul that paid in bitter tears 
For the glad helping of unnumbered fears, 
From the strange record of creation tore 
The sentence sad each sorrowing mother bore, 
Struck from the roll of pangs one awful sum, 
Made pain a dream, and suffering gently dumb ! 

Whatever triumphs still shall hold the mind, 
Whatever gift shall yet enrich mankind, 
Ah ! here no hour shall strike through all the years, 
No hour as sweet, as when hope, doubt, and fears, 
'Mid deepening stillness, watched one eager brain, 
With God-like will, decree the Death of Pain. 

How did we thank him ? Ah ! no joy-bells rang, 
No paeans greeted, and no poet sang, 
No cannon thundered from the guarded strand 
This mighty victory to a grateful land ! 
We took the gift, so humbly, simply given, 
And coldly selfish — left our debt to Heaven. 
How shall we thank him ? Hush ! A gladder hour 
Has struck for him ; a wiser, juster power 
81 



the birth Shall know full well how fitly to reward 

and death The generous soul that found the world so hard. 

O fruitful Mother ! — you whose thronging states 

Shall deal not vainly with man's changing fates, 

Of freeborn thought, or war's heroic deeds, — 

Much have your proud hands given, but nought exceeds 

This heaven-sent answer to the cry of prayer, 

This priceless gift which all mankind may share. 

A solemn hour for such as gravely pause 
To note the process of creation's laws ! 
Ah, surely He whose dark, unfathomed Mind 
With prescient thought the scheme of life designed, 
Who bade His highest creature slowly rise, 
Spurred by sad needs and lured by many a prize, 
Saw, with a God's pure joy, His ripening plan, 
His highest mercy brought by man to man. 
82 




REMARKS OF LORD PLAYFAIR 



>T the close of the programme, Lord Playfair, who was 
present, was asked to speak. 

Lord Playfair expressed special interest in the celebra- 
tion now in progress, partly due to the fact that he himself 
in the course of his life's work had made numerous exper- 
iments relating to means and methods of anaesthesia. 

On every occasion of this sort the name of Sir James Simpson must 
be mentioned with gratitude. The disinterested enthusiasm with 
which Dr. Simpson worked, regardless even of actual danger to him- 
self, was most praiseworthy. 

Lord Playfair told an amusing story of an experiment which he was 
about to conduct with Sir James Simpson in the direction of a sup- 
posed new anaesthetic method. Sir James came to him one day and 
told him that he was disgusted with chloroform, and would thank him 
very much for the discovery of a satisfactory substitute. Lord Play- 
fair a few days later announced to him that he had made the required 
discovery. The material that he intended to use was bi-bromide of 
ethylene. Sir James Simpson smelled the compound, and forthwith 
said that it was the very thing wanted. He was very anxious to repair 
immediately to Lord Playfair's private room and experiment upon 
himself. 

Lord Playfair was unwilling that the experiment should take place 
before further trial, and finally induced Sir James to have the anaes- 
thetic tried on some rabbits first. The rabbits were accordingly 
treated, and were put away to await developments. 

On the next day Dr. Simpson appeared at Lord Playfair's labora- 
tory, propped himself up with two chairs, and asked Lord Playfair for 
the solution. Lady Simpson, who was present, advised her husband 
to see how the rabbits had fared under the treatment before he 
applied it to himself. 

" When the attendant came in," continued Lord Playfair, " we saw 
him holding by the ears two rabbits — perfectly dead ! " 

83 



APPENDIX 




APPENDIX 



HOSPITAL RECORD OF THE FIRST PUBLIC ADMINIS- 
TRATION OF ETHER 

ILBERT ABBOTT, age twenty, painter, single ; tumor on 
face. This man had had from birth a tumor under the 
jaw, on the left side It occupies all space anterior to 
neck, bounded on the inside by median line, on the out- 
side is even with the edge of jaw ; below, on a level with 
the Pomum Adami, and in front tapers gradually as far as anterior 
edge of jaw; integuments not adherent to it; skin smooth and of 
natural color ; it is uniformly soft, except in centre, where a small, 
hard lump can be felt, corresponding in size and situation with sub- 
maxillary gland ; can be made to disappear by compression, but seems 
rather to be displaced than emptied. The edge of the lower jaw-bone 
can be felt, through the tumor, to be irregular. On examination of 
the inside of the mouth, find a soft, smooth tumor, a hemisphere about 
five lines in diameter, of a livid color, on the left lobe of tongue, 
about an inch behind tip. That portion of the organ in front and 
underneath the tumor is of a dark purple color. This tumor is readily 
emptied by slight pressure, but it fills again in one or two seconds, but 
not seoner when pressure is made simultaneously upon the external 
tumor. For distance of five lines from angle of mouth on right side 
the lower lip is of a livid hue. This seems to be a continuation of a 
stripe, similar in appearance, which extends from angle of jaw on 
right side about on level of lower teeth ; it is about four lines wide 
and slightly raised ; its color seems to depend on small spots like 
granulations, of a livid color, set on mucous membrane of ordinary 
appearance. 

This case is remarkable in the annals of surgery. It was the first 
surgical operation performed under the influence of ether. 

Dr. Warren had been applied to by Mr. Morton, a dentist, with the 
request that he would try the inhalation of a fluid which, he said, he 

87 



APPENDIX had found to be effectual in preventing pain during operations upon 

the teeth. Dr. Warren, having satisfied himself that the breathing of 
the fluid would be harmless, agreed to employ it when an opportunity 
presented. None occuring within a day or two in private practice, he 
determined to use it on this patient. Before the operation began, 
some time was lost waiting for Mr. Morton, and ultimately it was 
thought he would not appear. At length he arrived, and explained 
his detention by informing Dr. Warren that he had been occupied in 
preparing his apparatus, which consisted of a tube connected with a 
glass globe. This apparatus he then proceeded to apply, and after four 
or five minutes the patient appeared to be asleep, and the operation 
was performed as herein described. To the surprise of Dr. Warren 
and the other gentlemen present, the patient did not shrink, nor cry 
out, but during the insulation of the veins he began to move his limbs 
and utter extraordinary expressions, and these movements seemed to 
indicate the existence of pain ; but after he had recovered his faculties 
he said that he had experienced none, but only a sensation like that 
of scraping the part with a blunt instrument, and he ever afterward 
continued to say that he had not felt any pain. 

Note. — The results of this operation led to the repetition of the use 
of ether in other cases, and in a few days its success was established, 
and its use resorted to in every considerable operation in the city of 
Boston and its vicinity. 

Operation by Dr. Warren. — The patient having been placed in the 
operating chair in the amphitheatre, an incision, two and one half 
inches in length was made over the centre of external tumor, just 
beneath the edge of jaw, extending through skin and subcutaneous 
tissue. A layer of fascia was dissected off and disclosed a congeries 
of large veins and small arteries. Hemorrhage was slight, no vessel 
requiring ligature. A curved needle, armed with a ligature, size No. 
6, was passed under the mass, and the tumor included, under a knot 
with considerable compression. The wound was then filled with a 
small compress and lint, and the patient returned to bed. 

Patient continued to do well, and was discharged well, December 
7th. Cicatrix perfect ; tumor same size as on entrance, but no vessels 
to be detected in it. Tumor on tongue not altered, nor is appearance 
on inside of right cheek. General health much improved. 

88 



APPENDIX 
ACCOUNT OF AN EYE-WITNESS 1 

The day arrived ; the time appointed was noted on the dial, when 
the patient was led into the operating-room, and Dr. Warren and a 
board of the most eminent surgeons in the State were gathered 
around the sufferer. "All is ready — the stillness oppressive." It 
had been announced " that a test of some preparation was to be made 
for which the astonishing claim had been made that it would render 
the person operated upon free from pain." These are the words of 
Dr. Warren that broke the stillness. 

Those present were incredulous, and, as Dr. Morton had not arrived 
at the time appointed and fifteen minutes had passed, Dr. Warren 
said, with significant meaning, " I presume he is otherwise engaged." 
This was followed with a " derisive laugh," and Dr. Warren grasped 
his knife and was about to proceed with the operation. At that mo- 
ment Dr. Morton entered a side door, when Dr. Warren turned to him 
and in a strong voice said, " Well, sir, your patient is ready." In a 
few minutes he was ready for the surgeon's knife, when Dr. Morton 
said, " Your patient is ready, sir." 

Here the most sublime scene ever witnessed in the operating-room 
was presented, when the patient placed himself voluntarily upon the 
table, which was to become the altar of future fame. Not that he did 
so for the purpose of advancing the science of medicine, nor for the 
good of his fellow-men, for the act itself was purely a personal and 
selfish one. He was about to assist in solving a new and important 
problem of therapeutics, whose benefits were to be given to the whole 
civilized world, yet wholly unconscious of the sublimity of the occasion 
or the part he was taking. 

That was a supreme moment for a most wonderful discovery, and, 
had the patient died under the operation, science would have waited 
long to discover the hypnotic effects of some other remedy of equal 
potency and safety, and it may be properly questioned whether chlo- 
roform would have come into use as it has at the present time. 

The heroic bravery of the man who voluntarily placed himself upon 
the table, a subject for the surgeon's knife, should be recorded and 
his name enrolled upon parchment, which should be hung upon the 
walls of the surgical amphitheatre in which the operation was per- 
formed. His name was Gilbert Abbott. 

The operation was for a congenital tumor on the left side of the 

1 Dr. Washington Ayer, of San Francisco. 

8 9 



APPENDIX neck, extending along the jaw to the maxillary gland and into the 

mouth, embracing margin of the tongue. The operation was success- 
ful ; and when the patient recovered he declared he had suffered no 
pain. Dr. Warren turned to those present and said, " Gentlemen, this 
is no humbug." 



LETTERS FROM INVITED GUESTS 

London, September 14, 1896. 
My dear Dr. Warren : I beg you to allow me thus to thank you 
and the other members of the staff and the trustees of the Massachu- 
setts General Hospital for the invitation with which they have hon- 
ored me. I am deeply sorry that I cannot be present at the proposed 
commemoration of that which was certainly one of the most notable 
events in the history of surgery. 

I am sincerely yours, James Paget. 

Edinburgh, September 16, 1896. 

Dear Dr. Warren : Boston does well to commemorate the fiftieth 
anniversary of the day on which Dr. Morton first gave a public dem- 
onstration of the practicability of surgical anaesthesia, and so put into 
the hands of his professional brethren the means of saving the pa- 
tient from untold suffering. 

I thank you for your courteous invitation to the Massachusetts 
General Hospital on such a great occasion, and regret that my Uni- 
versity duties make it impossible for me to avail myself of your kind- 
ness. Believe me, 

Yours very faithfully, A. R. Simpson. 

Detroit, September 18, 1896. 

Dear Dr. Warren : I regret very much that I shall not be able to 
avail myself of the privilege of attending the exercises in commemo- 
ration of the first public demonstration of surgical anaesthesia. The 
occasion is one which cannot fail to excite an universal interest. It 
commemorates not only the birth of a procedure which has been an 
unspeakable blessing to the human race, but also the first great con- 
tribution made by American surgeons to the surgical science. 

It would seem highly proper, therefore, that every American sur- 
geon who cannot be present in person should express his warm con- 
gratulations to the trustees and staff of the great hospital, which was 
the scene of this great surgical exploit, in writing. 

90 



Please accept, my dear doctor, my sincere sympathy with you in APPENDIX 
your coming celebration. 

Yours cordially, Theodore A. McGraw. 

Toronto, September 30, 1896. 

Dear Dr. Warren : The idea of celebrating in your hospital the 
fiftieth anniversary of the first public demonstration of surgical anaes- 
thesia is a happy conception, and I should be delighted to attend the 
proposed function if it were possible for me to get away at the time. 

To no city in America is surgical science a greater debtor than to 
your own, and I would gladly take part in any procedures tending to the 
acknowledgment of debts that we can never hope to pay. There are 
no boundary lines limiting the spread of such beneficent discoveries 
as have been given to the world by the members of our profession in 
Boston. When I think of what the discoverers of anaesthesia, of 
what Holmes and Bigelow and Bowditch, and those who have borne 
and now bear the honored name of Warren, have done for us, our 
obligation weighs heavily, and we can but rejoice that through Lister 
and through the grand traditions of British surgery we are able in part 
to make a return. 

I wish you heartily a celebration worthy of the occasion and of the 
men who will take part in it, and am 

Yours sincerely, N. A. Powell. 

Frankfurt A. M., 27 Sept., 1896. 

Hochgeehrte Herren : Ihre sehr ehrenvolle Einladung zu der 
Commemoration of the Fiftieth Anniversary of Surgical Anaesthesia 
ist mir zugegangen. Sie war mir urn so erfreulicher als ich selbst eine 
der ersten war, der im Jahre 1846 in Berlin selbstandige versuche mit 
der ^Ether-Narkose gemacht hat. Niemand kann mehr als ich selbst 
von der Wichtigkeit dieser entdeckung uberzeugt sein, und ich wiirde 
mich glucklich schatzen, wenn ich Ihnen personlich meine Gliickwiin- 
sche aussprechen konnte. Aber die zeit gestattet mir nicht so kurz 
vor der Wieder beginnen meiner Vorlesungen Europa zu verlassen. 

Nehmen sie daher meine herzliche griisse und die Versicherung 
meiner aufrichtiger Hochschatzung der Amerikanische Heilkunst 
entgegen. Rudolf Virchow. 

Royal College of Surgeons of Edinburgh, 
5th October, 1896. 

Dr. J. Collins Warren. My dear Sir : I beg to thank you and 
the hospital staff for the honor of the invitation to the commemoration 

9 1 



APPENDIX of the fiftieth anniversary of that great discovery, surgical operation 

without pain. Distance alone prevents my being among you on the 
occasion. I had the pleasure of visiting Boston twelve years ago, and 
I hardly think it would be quite prudent at my age (now three years 
over the proverbial threescore and ten) to venture again across the 
great Atlantic. Among the pleasures I had in visiting America, as 
compared with the countries of Europe, was that of realizing that we 
are the same people. I admired Boston as, among American cities, 
reminding me most of home ; and I can recall the beautiful view of 
the Charles River from the window of dear old Oliver Wendell 
Holmes, one of those who have made Boston famous in literature and 
science. 

This commemoration brings up memories to me of the days of pre- 
anesthetic surgery in our old Royal Infirmary here, — the operating 
theatre ringing with the groans and shrieks of the patient, the dis- 
tressed faces of the crowd of students, and the haste of the operator 
to be done. I well remember, when the news came across the Atlan- 
tic, the first use of ether in that great theatre by my old masters, Syme 
and Miller. The change was wonderful j no longer pain, the patient 
lying nearly as quiet as the sleeper, and the operator undisturbed and 
risking nothing by haste. 

It is well that this commemoration should be held, not merely that 
such a great event deserves celebration, but in order to remind the 
young generation that has since grown up that these benefits which 
they (patients and surgeons alike) now enjoy were not always. I may 
add that the celebration is more particularly required among us here. 
Ether, or a mixture of ether and chloroform, seems to be the anaes- 
thetic most commonly employed in England ; but here, and in Scotland 
generally, it is so almost invariably chloroform that the word " chloro- 
form " has come to be identified in the public mind with painless oper- 
ation, as if chloroform had been the discovery. I do not mention this 
as in diminution of the merit of Sir James Simpson, one of my old 
teachers, in the subsequent discovery of the anaesthetic property of 
chloroform ; but magna est Veritas, and it is well to keep our public in 
mind that we owe the great discovery to our American brethren. 

In return, we have sent you the no less great boon of antiseptic 
surgery. We were but last month, at the meeting of the British Asso- 
ciation at Liverpool, paying renewed honor to Sir Joseph Lister, my 
former colleague on the surgical staff of the old Royal Infirmary here, 
as the man to whom we and the world owe this great boon in surgery. 
It is quite wonderful for me to see, when I visit our new Royal Infir- 
mary, what can now be done under antiseptic treatment, — things we 

92 



would not have ventured on in the old days. And now we are having APPENDIX 
the Rontgen rays, letting us actually see the bones in the living body. 
It has, indeed, been a half century of wonderful progress. 

But I must bring this too long letter to a close. I beg to congrat- 
ulate the Massachusetts General Hospital on having been the scene 
of the first public demonstration of the great discovery ; and, if I am 
right in my impression that it was by your hands, I no less congratu- 
late you on having lived to see half a century of the fruition of your 
example. I have the honor to be, 

Yours very sincerely, John Struthers, 

President of the College. 

San Francisco, Cal., October 7, 1896. 

Dear Dr. Warren : Great events make memorable history. The 
eventful discovery of ether owns the most brilliant page in the history 
of medicine, — a page full of the recorded blessings of anaesthesia ; 
and yet at the close of the nineteenth century who can tell what other 
great discoveries will soon follow to relieve human suffering ? While 
being thankful for the past, let us be hopeful for the future. 

California sends greeting to Boston upon the semi-centennial anni- 
versary of the discovery of ether. While steel and iron ties bind the 
shores of the Pacific and Atlantic together, still stronger ties unite 
the Occident to the Orient in bonds of unity, — the ties of fraternal 
love and good-fellowship for the members of the noble profession 
of medicine. I well remember the simple preparation made in the 
amphitheatre of the Massachusetts General Hospital for the most 
important surgical operation the world ever witnessed, which gave 
painless surgery to the world. There was no display, no ostentation, 
but the profound silence told the importance of the occasion. Then 
Dr. W. T. G. Morton administered the ether, and Dr. John C. Warren 
performed the operation, and the anxious suspense was over when the 
apparently lifeless body of the patient began to move. A new revela- 
tion was then given to the world, and the scene that followed no pen 
will ever be able faithfully to describe ; but, after fifty years, it is fresh 
before me, like a living picture daguerreotyped on the memory, there 
to remain forever. 

I hoped to revisit the scenes of my youth and be present at this 
grand jubilee, held in commemoration of the most important event in 
the history of medicine, but sickness compels me to forego the pleas- 
ure, while the world rejoices in the benefactions bequeathed to suffer- 
ing humanity by the discovery of ether. 

Yours sincerely, Washington Ayer. 

93 



APPENDIX Sir Richard Quain sincerely regrets that distance renders it im- 

practicable for him to attend the fiftieth anniversary of the public 
demonstration of surgical anaesthesia at the Massachusetts General 
Hospital on October 16, 1896. He heartily congratulates the institu- 
tion whence has emanated one of the greatest blessings ever con- 
ferred upon mankind. 

He sends a copy of an address which he once gave the students of 
University College, London, in which a brief statement is made as to 
the introduction of anaesthesia into Europe : — 

" Robert Liston was one of the greatest of modern surgeons. I 
would, however, desire especially to emphasize the fact that it was 
Mr. Liston who in our hospital performed the first operation under 
anaesthetics in this country. The facts, of which I was a witness, will 
be found fully recorded in the first volume of the ' Lancet ' for 1847. 
The story briefly told is this : that Mr. Morton, a dentist in Boston 
in the United States, used sulphuric ether to produce insensibility to 
pain during the removal of teeth. Subsequently some capital opera- 
tions were performed in the Massachusetts Hospital without pain. 
This success was communicated through Dr. Boott, a retired American 
physician who resided in Gower Street, and who was a zealous mem- 
ber of the Council of our College, to Mr. Liston, who, influenced by 
the statement, saw Mr. Robinson, a dentist in Gower Street, remove a 
tooth, as Mr. Morton had done on several occasions in Boston, and 
the result is told in the following note from Mr. Liston : — 

ut Clifford Street, December 21, 1846. 
" * My dear Sir : I have tried ether inhalation to-day in a case of 
amputation of the thigh, and in another requiring evulsion of both 
sides of the great toe-nail, with the most perfect and satisfactory re- 
sults. It is a very great matter to be thus able to destroy sensibility 
to such an extent and without any apparently bad result. It is a fine 
thing for operating surgeons, and I thank you most sincerely for the 
early information you were so good as to give me of it. 

" ' Yours faithfully, Robert Liston/ 

" Thus anaesthesia, that great boon to mankind, was introduced in 
this country at University College Hospital by one of its surgeons. 
The nature of the anaesthetic, of which there are now, as you know, 
several, was really a subject of secondary importance. The * oil of 
wine ' and also ' choric ether ' had been tried in America." 

94 



APPENDIX 
CONGRATULATIONS BY CABLE 

The following cablegrams were read by the Chairman, Dr. J. C. 
Warren, at the opening of the exercises celebrating the semi-centen- 
nial of anaesthesia on October 16th : — 

Christian ia, October 16, 1896. 
Trustees and Staff Massachusetts General Hospital, Boston : 
Best congratulations on fiftieth anniversary. 

CESAR Bceck. 

Moscow, October 16, 1896. 
Boston, Massachusetts General Hospital. Collins Warren : 
The Moscow Surgical Society, at a special meeting held in honor of 
the fiftieth anniversary of the introduction of anaesthetics, celebrates 
the memory of Morton and Simpson, the great benefactors of man- 
kind. It greets the committee, and wishes it every success in its labors 
on behalf of science, which knows no geographical boundary. 

Diakon, President. 
Warneck, Secretary. 

95 






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